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Understanding Hip Pathology: A Layered Approach by Alan Zhang MD, Study notes of Pathology

Withlacoochee Technical InstitutePathology

An in-depth analysis of the hip, focusing on the four layers of hip pathology: osteochondral, inert, contractile, and neuromechanical. Each layer is discussed in detail, including structures, pathologies, and diagnostic exams. The document also covers physical exam techniques and common hip conditions such as FAI, trochanteric pathology, and sports hernia.

What you will learn

  • How is hip pathology diagnosed?
  • What are some common hip conditions discussed in the document?
  • What structures are included in each layer of hip pathology?
  • What are the four layers of hip pathology?
  • What are the common pathologies associated with each layer of hip pathology?

Typology: Study notes

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The Hip Exam for the Generalist
Alan Zhang MD
Assistant Professor
Sports Medicine and Hip Arthroscopy
UCSF Department of Orthopaedic Surgery
The Layers of the Hip
To treat hip pathology-
1st task is to understand the source of hip pain
Bryan Kelly et al Arthroscopy 2012
• Layer 1- Osteochondral
• Layer 2- Inert
• Layer 3- Contracile
• Layer 4- Neuromechanical
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Download Understanding Hip Pathology: A Layered Approach by Alan Zhang MD and more Study notes Pathology in PDF only on Docsity!

The Hip Exam for the Generalist

Alan Zhang MD

Assistant Professor Sports Medicine and Hip Arthroscopy UCSF Department of Orthopaedic Surgery

The Layers of the Hip

 To treat hip pathology-  1 st^ task is to understand the source of hip pain  Bryan Kelly et al Arthroscopy 2012

  • Layer 1- Osteochondral
  • Layer 2- Inert
  • Layer 3- Contracile
  • Layer 4- Neuromechanical

2

Layer 1- Osteochondral

 Structures

  • Femur
  • Acetabulum
  • Articular cartilage

 Pathology

  • Cam impingement
  • Pincer impingement
  • Subspine impingement
  • Articular cartilage delamination

3

Layer 2- Inert

 Structures

  • Capsule
  • Labrum
  • Ligamentum teres

 Pathology

  • Labral tear
  • Capsular instability
  • Adhesive capsulitis

4

Location, Location, Location

 Anterior/groin

  • FAI
  • Arthritis
  • Flexor strain  Lateral/thigh
  • Trochanteric pathology
  • Snapping hip  Buttock/posterior
  • Low back/sciatic nerve
  • Referred pain

7

Physical Exam

 Asses ambulation

  • Antalgic gait ‒ Arthritis/acute injury
  • Trendelenberg gait/Single leg stance ‒ Trochanteric pathology ‒ Gluteus tear
  • FAI gait ‒ Loss of peak hip extension

Trendelenberg Gait

FAI gait

 FAI gait

  • Loss of peak hip extension

 Zhang et al AJSM 2016

  • Increased hip joint loading in FAI patients

Strength/Muscle Exam

 Rectus—hip flexion against resistance  Abductors—push out legs  Adductors—pull in legs

Provocative Exams

 Log roll  FADIR  FABER  Labral stress test/ Scour test  Sports hernia exam  Straight leg raise

14

Log Roll

 Assess for intra-articular hip pathology

15

Flexion ADduction Internal Rotation

Flexion ABduction External Rotation

Labral Testing/Scour Test

Sports Hernia (Athletic Pubalgia)

 Strain or tear of soft tissue in lower abdomen or groin area

  • Inguinal disruption
  • Adductor injury
  • Abdominal wall injury

21

Sports Hernia Exam

Palpation

  • Pubic symphysis/Pubic tubercle
  • Insertion of rectus (confluence of structures)
  • Adductor origin (AL, AB, pectineus)
  • Superficial inguinal ring ‒ Rule out true hernia ‒ Size of ring (dilation indicates weakened area) ‒ Check tenderness of posterior wall

22

Lateral Exam

 OBER test

  • IT band tightness  Palpate Greater Trochanter
  • Trochanteric bursitis  Gluteus Medius strength testing

Ober Test

26

Gluteus Medius Strength Test

27

Prone exam

 Hamstring exam

  • Palpate for defects
  • Evaluate for weakness